Exercise as medicine

If we want to feel better and live longer, turns out we should walk past the pharmacy and, well, just keep on walking! OHbaby! Fitness expert Renée Vincent explains.

If a friend told you about an inexpensive wonder drug that adds years to your life, prevents and treats dozens of diseases and even improves your quality of life, I’m sure you would be keen to know more about it. You might wonder what the catch is, only to be amazed to find out that this drug has very few negative side effects when taken in the correct dose. It might be hard to believe that this wonder drug has been shown to help prevent type 2 diabetes, osteoporosis and some cancers (colon, prostate, and breast). It can actually treat type 2 diabetes and some blood lipid disorders, and help prevent and treat heart disease, stroke, high blood pressure, and obesity and its associated problems. And it can even delay the effects of ageing and improve your health and wellbeing, at any age.

But when I tell you that the wonder drug I’m talking about is in fact exercise, you may well be disappointed. You might feel like you have heard it all before. Those of us who are less inclined to be active easily overlook the immediate benefits of exercise – such as improved mental and physical wellbeing – and think more of exercise as something we have to do to help us prevent diseases that we find it hard to imagine ever having. This, in turn, means that we allow ourselves to be put off by obstacles (eg. I’m too busy, too tired, I don’t have childcare) and thus fail to get the World Health Organization’s recommended 300 minutes of exercise per week.

GRAVE CONCERNS
As a recent article published in medical journal The Lancet and entitled The pandemic of physical inactivity: global action for public health concluded, we should be viewing physical inactivity with the same concern we give other global threats to human health: "In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences”.

Therefore we need to get serious about marketing and promoting exercise in a way that really gets people moving, and a potentially effective way to do this is to ‘sell’ it as a wonder drug. Speaking at a recent New Zealand sports medicine conference about a global initiative called Exercise is Medicine, Dr Robert Sallis introduced a novel way of viewing exercise. He presented exercise packaged and marketed in the same way drug companies package and market their drugs – complete with indications, benefits, contraindications and side effects.

MAY CAUSE LIFESTYLE CHANGES
When cleverly framed in this way, exercise stands out as an amazing wonder drug that few others can compete with in terms of the number of medical conditions that it can help. It also has a comparatively short list of side effects. I challenge you to read the leaflet that comes with the next medicine that is prescribed to you – more often than not there will be a long list of potentially unpleasant side effects. This is one of the reasons many people have turned to natural medicine and alternative therapies – of which exercise should be included as a powerful example.

What quickly becomes clear when reading the information available at exerciseismedicine.org is that we need to get real about actively taking responsibility for our health. Lifestyle factors, such as exercising, our diet and smoking, contribute a whopping 50% to our overall health status. Waiting until we are diagnosed with a health condition and then taking a prescription medicine is simply not an effective approach. We need to be prepared to make lifestyle changes before we develop chronic health conditions and we need to commit to regular exercise.

The aim of the Exercise is Medicine health initiative is to get GPs and other health providers to assess a patient's activity levels at every visit and to include physical activity in their treatment plans. Exercise is Medicine offers a wide range of resources to help GPs and health providers be able to easily assess patients and then prescribe exercise.

GREEN MEANS GO
In New Zealand we have a similar initiative in place called the Green Prescription initiative. It is designed to help people become more active. When a GP or nurse issues a Green Prescription, the patient’s name is referred to a contracted provider in the local area. For example, in Central and South Auckland this is Sport Auckland. The Green Prescription provider would then support the person in identifying ways to become active and assist them in establishing and maintaining an active lifestyle. This might be through one-on-one sessions, phone support or through community groups that provide education. However, currently the Green Prescription is only available to people who have an established medical condition, such as prediabetes and diabetes, high blood pressure or cholesterol, heart disease, obesity or stress/anxiety. The good news is that women who are pregnant and at risk of (or who have) gestational diabetes will soon become eligible. Women recovering from postpartum depression may also be eligible.

Many inactive parents without health issues would not therefore qualify for this support in becoming active under the Green Prescription. Interestingly, this is one of the groups that Exercise is Medicine is specifically trying to target – a group they call the ‘apparently healthy’. If you have no current health problems or obvious symptoms of ill health, then it is easy to be in denial about the fact that you are still at risk for a myriad of health problems that exercise can provide significant protection against. Just because you feel healthy now doesn’t mean you always will!

So if you are inactive but apparently healthy, and don’t qualify for a Green Prescription, you need to become your own coach, trainer and cheerleader, and find the ways that work for you to become physically active. For some people, the process of becoming more active may need to start with redefining exercise. Recently a friend pointed out that the word exercise can be off-putting in itself, as some people immediately associate it with structured activity that they don’t necessarily enjoy, at an intensity that does not feel achievable for them.

If you are one of the many for whom ‘exercise’ takes on negative connotations, then try thinking instead of the word ‘movement’. What is important here is that you move, and that movement can take on endless forms. Movement is likely to include any kind of physical activity, such as gardening, playing with the kids, even vigorous vacuuming. However, I think it is useful to realise that activity needs to be intentional, daily and as high-intensity as you can achieve without injury.

PLAN TO SUCCEED
If you’ve always had an exercise habit, then being active is something you don’t even have to think about. For example, you find yourself with a spare 20 minutes and you have your shoes on and are running out the door before you know it. Or you have an opportunity to go to the pool with a friend and you jump at the chance. But if life has thrown you some obstacles and challenges – for example, you haven’t been able to get into an exercise routine after having a baby, you have had a sick toddler for months, you’ve been caring for a sick relative, or have just started back at work and the baby still wakes three times at night – then you are going to have to make a plan.

Busy parents have to create time and opportunities to exercise, and that’s not always easy. But if you look around, there are plenty of people making it happen – use these people for inspiration and approach them for ideas. Talk to your support people and see if you can get help with the kids so you can get out.
Get creative with your family time and factor in the beach, the pool or the park whenever you can. Look for flexibility with how you share the childcare at home. Perhaps you can get out for an early workout or to a class in the evening. You may also need to get some professional support and advice from a health or fitness provider, especially if you are pregnant or have any current aches and pains or health issues.

The old saying "where there is a will, there is a way" really holds true for lifestyle changes. I have seen friends and family transform their lifestyles when diagnosed with cancer or heart disease. What we need to get clear in our minds, now more than ever, is that those lifestyle changes should happen now, before we get a diagnosis. By arming ourselves with information, growing our motivation and surrounding ourselves with people who inspire and encourage us, we can be more than ‘apparently healthy’ – we can offer ourselves the protection of the amazing wonder drug, exercise. Remember, exercise is medicine. Find exercise or movement that you enjoy, prescribe it to yourself in the correct dose (enough to be effective but not so much that you have negative side effects), and take it religiously for the rest of your life.